A One Year Cross Sectional Study to Determine the Relationship between Serum Lipid Profile And Diabetic Retinopathy

Abstract

INTRODUCTION ABSTRACT Diabetic retinopathy remains the number one cause of new blindness in developed countries. The trend is catching up in developing countries such as ours where this clinical entity is fast gaining importance as a disease of major public health importance. Dyslipidemia in diabetes patients may act as predisposing risk factor, an aggravating or complicating risk factor. Its clear role in microvascular complications however is yet to be understood. An understanding of the relationship between various grades of diabetic retinopathy with the lipid profile will be helpful in stratification and tailoring of anti diabetic and lipid lowering treatment for diabetic retinopathy. OBJECTIVE OF THE STUDY: To determine the relationship of serum lipid profile and glycemic control with the fundus changes in patients with type II diabetes mellitus and also to correlate the severity of diabetic retinopathy with duration of diabetes. METHODOLOGY It was a one year cross sectional study which included 100 patients of diabetic retinopathy whose retinopathy was classified into different grades based on Kanski’s classification. After taking informed consent all patients were examined according to a pre designed proforma. Relevant history was taken and general physical examination was performed followed by a complete ophthalmic examination. A detailed fundus evaluation was performed using a direct, indirect ophthalmoscopy along with slitlamp biomicroscopy with +90D lens. Patients with ocular media haze, other degenerative lesions of the fundus, uncontrolled hypertension, pregnancy, coronary heart disease, hepatic diseases and on lipid lowering drugs were excluded from the study. Investigations performed in these patients were fasting blood sugar levels, Glycosylated hemoglobin ( HbA 1C ) levels to determine the glycaemic control and estimation of serum Lipid profile. ( Total cholesterol, LDL, HDL, Triglycerides & LDL/HDL Ratio ) OBSERVATIONS AND RESULTS Progression of retinopathy was more with raised total cholesterol and decreased HDL-cholesterol levels. There was a significant increase of LDL / HDL ratio and serum triglycerides with increasing severity of retinopathy. Patients with longer duration of diabetes had more severe grades of diabetic retinopathy and poor glycemic control led to the worsening of the retinopathy. CONCLUSION The raised Total cholesterol, LDL, Triglycerides and lower HDL cholesterol levels were clearly associated with progression of severity of diabetic retinopathy. The results in our study indicate the hope of pharmacological intervention to reduce the lipid levels in patients of diabetic retinopathy with raised total cholesterol levels inorder to retard its progression.